Re: [Gnumed-devel] Billing/LedgerSMB gap analysis

From:

Karsten Hilbert

Subject:

Re: [Gnumed-devel] Billing/LedgerSMB gap analysis

Date:

Thu, 16 Jun 2011 09:07:01 +0200

User-agent:

Mutt/1.5.21 (2010-09-15)

On Wed, Jun 15, 2011 at 01:26:45PM -0700, Jim Busser wrote:
>
> > What I think we'd need to do this with a minimum of grace would be an
> > add-on for handling third party payments. In this model, you'd have
> > an additional bill-to contact that would get the first invoice, and a
> > second bill-to contact that would get the invoice if declined,
> > refused, etc. For private pay, there would be no additional bill to
> > contact.
>
> A fee of $35.00, which could work multiple ways:
>
> 1) the bill for $35.00 is sent to the insurer InsurCo who refuses to pay
> --> the bill-to gets changed from InsurCo to patient-pay
> ? does LSMB allow it to be later seen that InsurCo was approached but
> refused?
>
> 2) the bill for $35.00 is sent to the insurer InsurCo who will pay only $25
> --> does this remain a single bill, whose balance is paid by someone
> else?
> or is $10.00 "split off" to make a new bill?
>
> 3) it is known in advance that insurCo will pay only $25.00
> --> $10.00 "split off" to make a new bill payable by patient
> --> the remaining $25.00 "is right away billed to InsurCo
>
> Does LSMB already handle the above?
Well, as far as I understood Chris' gap analysis, no, it
does not. He also said that the current LSMB structure does
not easily support this model.
However, we are trying to define a use case even easier than that:
The bill for $35.00 goes to the patient and if they
don't pay up within, say, 4 weeks, we send out the Gang
of Five.
That use case will apply in large swaths of the world.
Karsten
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